Song Joon K, Niimi Yasunari, Fernandez Patricia M, Brisman Jonathan L, Buciuc Razvan, Kupersmith Mark J, Berenstein Alejandro
Center for Endovascular Surgery, Hyman-Newman Institute for Neurology and Neurosurgery, Beth Israel Hospital, Singer Division, New York, NY, USA.
AJNR Am J Neuroradiol. 2004 Aug;25(7):1147-53.
The management of thrombus formation during coil placement in an intracranial aneurysm is important in minimizing periprocedural morbidity and mortality. We report on seven cases in which the primary treatment for thrombus formation during such coil placement was intra-arterial abciximab infusion.
Clinical and radiologic records of 100 consecutive patients who underwent coil placement in intracranial aneurysms at our institution during a 1-year period were reviewed. We identified seven cases (four ruptured aneurysms, three unruptured aneurysms) in which thrombus formation occurred during the procedure.
Intra-arterial abciximab infusion, up to 5 mg, completely dissolved the thrombus in four of seven patients and almost completely dissolved it in two. In one patient with distal emboli, recanalization was not achieved. In two patients, an intravenous bolus of abciximab without 12-hour infusion was also given adjunctively. In one patient, leakage of contrast material occurred; this was related to the intra-arterial infusion. Clinically, no new neurologic deficits were directly related to the intra-arterial abciximab infusion. Six patients had good clinical outcome, and one patient died.
Relatively low-dose, intra-arterial abciximab infusion can immediately dissolve an acute thrombus that forms during intracranial aneurysm coil placement. Although neither the optimal dose of intra-arterial abciximab nor the need to supplement the intra-arterial infusion with intravenous administration was established, we preliminarily found that low-dose intra-arterial abciximab infusion may be relatively effective and safe in this setting, even in patients with acute subarachnoid hemorrhage.
在颅内动脉瘤中进行弹簧圈置入时，血栓形成的管理对于将围手术期发病率和死亡率降至最低至关重要。我们报告了7例在这种弹簧圈置入过程中血栓形成的主要治疗方法为动脉内输注阿昔单抗的病例。
回顾了我院在1年期间连续100例行颅内动脉瘤弹簧圈置入患者的临床和放射学记录。我们确定了7例（4例破裂动脉瘤，3例未破裂动脉瘤）在手术过程中发生血栓形成的病例。
动脉内输注阿昔单抗，剂量高达5mg，使7例患者中的4例血栓完全溶解，2例几乎完全溶解。1例远端栓塞患者未实现再通。2例患者还辅助静脉推注阿昔单抗，未进行12小时输注。1例患者发生造影剂渗漏；这与动脉内输注有关。临床上，没有新的神经功能缺损与动脉内输注阿昔单抗直接相关。6例患者临床预后良好，1例患者死亡。
相对低剂量的动脉内输注阿昔单抗可立即溶解颅内动脉瘤弹簧圈置入过程中形成的急性血栓。虽然尚未确定动脉内阿昔单抗的最佳剂量以及是否需要用静脉给药补充动脉内输注，但我们初步发现，在这种情况下，低剂量动脉内输注阿昔单抗可能相对有效且安全，即使在急性蛛网膜下腔出血患者中也是如此。
